<!doctype html>
<html>
<head>
<meta charset="utf-8">
<title></title>
<?php include('include/include_link.php');?>  
</head>

<body>
<?php include('include/variable_session.php');?>   
        
	<div id="wraper" class="main_container">  
            <?php include('include/header.php');?>      
            <div class="compte-patient">
            <table>
            <tr>
                <td id="inscriptionPatient" align="center">
                    <form method="post" action="<?php echo base_url();?>patient/addComptePatient">
                        <table  align="center">
                            <tr>
                                                                
                                <td colspan="2">INSCRIPTION PATIENT</td>
                            </tr>
                            <tr>
                                <td>Civilite :</td>
				<td>
				<select name="civilite" id="civilite" >
                                    <option value="mr">M.</option>
                                    <option value="miss">Mlle</option>
                                    <option value="mrs">Mme</option>
                                </select>
				</td>
                            </tr>
                            <tr>
                                <td>NOM :</td>
                                <td><input type="text" name="nom" id="nom" /></td>
                            </tr>
                            <tr>
                                <td>PRENOM :</td>
                                <td><input type="text" name="prenom" id="prenom" /></td>
                            </tr>
                            <tr>
                                <td>EMAIL</td>
                                <td><input type="text" name="email" id="email" /></td>
                            </tr>
                            <tr>
                                <td>MOT DE PASSE</td>
                                <td><input type="password" id="password_patient" name="password_patient" /></td>
                            </tr>
                            <tr>
                                <td colspan="2">
                                    <div id="lue"><input type='checkbox' value='lu' name="lu" /> J'ai lu et j'accepte <a href="<?php echo base_url();?>dn/condition" target="_blank">les conditions d'utilisation</a> 
                                    </div> 
                                </td>
                            </tr>
                            <tr>
                                <td colspan="2"><input type="submit" value="S'inscrire" /></td>
                            </tr>

                        </table>
                    </form>
                </td>
                <td id="connexionPatient" align="center">
                    <form method="post" action="<?php echo base_url(); ?>patient/connexionPatient">
                        <table>
                            <tr>
                                <td colspan="2">CONNEXION PATIENT</td>
                            </tr>
                            <tr>
                                <td>Adresse email</td>
                                <td><input type="email" id="email" name="email" size="25"/></td>
                            </tr>
                            <tr>
                                <td>Mot de passe</td>
                                <td><input type="password" id="password_patient" name="password_patient" size="25"/></td>
                            </tr>
                            <tr>
                                <td colspan="2"><input type="submit" value="CONNEXION" /></td>
                            </tr>
                        </table>
                    </form>
                </td>
            </tr>
        </table>
                
            </div>
            
            <br />
            <br />
            <br />
            <br />
            <br />
            <br />
            <br />
            <br />
            <br />
            <br />
            <br />
            
            
            
        </div>
    <?php include('include/footer.php'); ?>
        
        
</body>
</html>
